Is it normal for insurance companies to request a treatment plan for a member you provide services to?

[texanpsychdoc]

I got a voice message from a BCBS RN case manager requesting a treatment plan from me for a member of theirs I see. Is this typical? What should I expect? What do you do?

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[psych.meout]

I'm on internship at an AMC in a large health system and we need to have treatment plans for every therapy patient and they need to be reviewed and updated at least every 90 days.

 

[texanpsychdoc]

Yes, I do treatment plans routinely and that's not the issue at hand tho. I am curious to see what others have done when approached by an insurance company requesting said treatment plan. Are they looking for something in particular, are they looking to claw back money, etc.

 

[WisNeuro]

Yes, I do treatment plans routinely and that's not the issue at hand tho. I am curious to see what others have done when approached by an insurance company requesting said treatment plan. Are they looking for something in particular, are they looking to claw back money, etc.

If you don't meet their documentation standards, they can.

 

[AcronymAllergy]

I can only answer based on second-hand knowledge, as I currently don't provide insurance-based therapy. I don't know if I'd say it's typical, but it's not atypical, at least from what I've heard.

 

[texanpsychdoc]

So some things stand out to me about what has come up. The person who called me evidently called me via Psychology Today as I received a notification from PT that "Blue Cross Blue" had called me. The person left a number to call back that was not the number they called me from, so, when I called it, the voice recording said "you have called Blue Cross and Blue Shield Managed Care, please enter the 5 digit extension of the care provider you wish to reach."

After finally getting ahold of the supposed case manager, the person told me they were looking for me to send them a single treatment plan for a patient I have and they did indeed name the person's name. I advised them I didn't have a fax machine, so they said I could email it to them. They asked me for my email (which I found odd as BCBS should have this info on file already). When I further inquired as to if they will send me an email that is encrypted they started "I was going to email you from my company email." So that was odd. Needless to say, I have yet to receive an email from them.

They mentioned this was just to find out if the member is receiving all the healthcare services they are entitled to or would benefit from, and that this was not an audit, nor would this be a situation where they would want me to modify anything in terms of my documentation.